The most compelling evidence of fluoridation`s benefits came from studies conducted in seven Chicago-area towns just before America`s entry into World War II. Dean headed a team that examined the dental histories of 2,509 children between ages 12 and 14 who had grown up in the communities. Elmhurst, Maywood, Aurora and Joliet each had a natural content of at least one part fluoride per million in their drinking water. Evanston, Oak Park and Waukegan had no naturally occurring fluoride in theirs. The study, published in 1941, showed that children who grew up drinking fluoridated water developed only about one-fourth as many cavities as those who did not.
Dean began planning an experimental program of artificial water fluoridation. Most cities and towns already had water-treatment plants, and it seemed that it would be easy to install machinery that would feed fluoride ions into the water supply before it left the plants. If naturally occurring fluoride was so beneficial to dental health, why not deliberately salt community drinking water supplies that contained no fluorides?
Dean carefully selected Grand Rapids, Mich., as the first city to receive artificially fluoridated water, in part because federal and state officials he consulted thought the political atmosphere of the city was informed and stable enough to stick with the experiment for 10 years.
”There were no signs of apprehension, of daring or of pioneering (among those working on the project),” the late John W. Knutson wrote in a memoir in 1969. Knutson was a dentist and federal health official who helped Dean set up the Grand Rapids experiment. ”There were no implications or inferences that we were being foolhardy in subjecting a population of 160,000 people to a procedure which might have either short- or long-range hazards. We were merely replicating nature`s best, based on an extensive background of study data in nature`s laboratory, a laboratory which was extremely large.”
Thus Grand Rapids came to have, in January, 1945, the first artificially fluoridated drinking-water supply in the world. Within a couple of years, similar experiments followed in Newburgh, N.Y.; Sheboygan, Wis.; and Evanston. The new knowledge that flowed from those early experiments should rank as one of the great medical achievements of this or any other age. But not much glory ever showered on the fluoridation experiments. From the start in Grand Rapids, there were signs that not everybody in the city was as confident of fluoridation`s safety as the scientists and public officials.
Knutson recalled in his memoir: ”Shortly after Jan. 1, 1945, the announced time for beginning fluoridation in Grand Rapids, there were complaints of ill effects: `Since they`ve been adding that fluoride in our drinking water, I have been gaining weight rapidly` and, `Bathing in fluoridated water is causing a rash all over my body.`
”Fortunately, complaints such as these were made prior to the actual beginning of fluoridation, which had been delayed until Jan. 25 because of unexpected problems in getting delivery of equipment.”
The public health service at first clamped a tight lid on its work in Grand Rapids, not wishing to raise false hopes or fears in the public. The secrecy proved to be nettlesome to many dentists and public health officials around the country who already were convinced that fluoridation was safe and effective. They wanted immediate fluoridation in their communities and considered the 10-year wait an action bordering on criminal. The dental health of millions of children hung in the balance.
Public pressure for immediate fluoridation was strongest in Wisconsin. A group of zealous dentists there cited Dean`s earlier data on the cavity-fighting benefits of fluorides in naturally fluoridated communities. They also cited the spectacular early results coming out in dribs and drabs from Grand Rapids, Sheboygan, Evanston and Newburgh. Crisscrossing Wisconsin, they convinced one city government after another not to wait a day longer, to fluoridate their drinking water immediately.
By 1950, 50 cities and towns in Wisconsin were fluoridating. The Wisconsin dentists were so successful in their efforts that the U.S. Public Health Service and the American Dental Association backed down from their cautious stands the same year. Both organizations publicly encouraged communities to fluoridate on the basis of the first five years of the Grand Rapids experiment.
It looked like everybody in the country would be drinking fluoridated water as soon as machinery could be manufactured. It also looked like Wisconsin would be the first fully fluoridated state. In those early days the decision to fluoridate in any community was largely an administrative one that could be put into effect simply by city or village council approval.
By 1950, however, the world was becoming a complicated, anxiety-ridden place. Research laboratories and universities began using improved computer technology, and scientific knowledge touching all areas of life began expanding in scope and in depth at a rate that no one human being could keep up with. The constant bombardment of new information and ideas set off a love- hate relationship between science and the public.
Science continues to make our lives easier. It has abolished dreaded diseases and brought organ transplantation. We sometimes hold science in almost religious awe, convinced that it will produce answers to allay our deepest fears. It is like the heavy smoker who continues to tempt fate rather than quit, convinced that science will produce the ultimate pill that will do away with cancer and heart disease before the odds catch up with him.
On the other hand, science and the new ideas it produces are the source of some of our deepest fears. Years ago we were fascinated when science assured us that it had harnessed the atom to provide us with safe, efficient nuclear energy. Then came the accidents at Three Mile Island in Pennsylvania and Chernobyl in the Soviet Union and the realization that nobody really knows what will happen if a nuclear power station goes amok. Until this year, when the space shuttle Challenger exploded, Americans were lulled into thinking that manned space flight was so rigorously monitored that it had become virtually as safe as airplane travel. A new synthetic tranquilizer once came on the market, advertised as the safest ever, the result of years of scientific testing that showed it to be nontoxic and without side effects. Grateful doctors begin prescribing it widely; their patients included pregnant women. That tranquilizer was Thalidomide. Those mothers who took the drug in the crucial first three months of their pregnancies later gave birth to horribly deformed babies.
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We wonder and worry about all the additives used in modern processing and production of our foods and beverages. Are all those chemicals safe? Is there anybody who really knows all the long-term ramifications of ingesting them?
Groundless or not, those sorts of fears have produced enough general anxiety to give birth to a gigantic ”health food” industry. The fluoridation question became a spectacular example of those doubts and fears. It illustrates the confusion that reigns in a highly technological society in which the average person has to accept the guidance of experts. It also illustrates the fragility of the contract between science and society, a case in which, contrary to all evidence, the public sometimes refuses to accept expert opinion on faith. Even before the federal government and the ADA gave their blessing to fluoridation, a ”man-on-the-street” backlash was fermenting. The backlash finally erupted, appropriately enough, in Wisconsin, as historian Donald McNeil has documented in his book, ”The Fight for Fluoridation.”
In the summer of 1949 Wisconsin`s zealous band of pro-fluoridation dentists brought their campaign to Stevens Point, a city of 15,000 in the center of the state. They were holding an informational meeting at the town`s American Legion hall when a man in the crowd stood up. He wanted to know why the dentists would propose putting fluoride, a known ”poison,” in the drinking water. He began to berate the dentists as ”fakers” who wanted to pollute the fresh clear water of Stevens Point.
The man, Alexander Y. Wallace, may or may not have swayed the crowd at the American Legion post. Wallace, then 67, was the city`s last surviving Spanish-American War veteran. Claiming to be a Socialist, he was the feisty local eccentric, the sort much-beloved in Midwestern small towns for their constant espousal of exotic and quixotic causes. A former Stevens Point city clerk, he was a self-styled poet who was well-known to newspapers around Wisconsin for his barrage of letters, explosively expressing his opinions on issues that intrigued him, such as the pasteurization of milk (he was against it).
Shortly after the meeting, in July, 1949, the Stevens Point city council voted against installing fluoridation equipment. The council`s action was a reasonable one, falling on the side of caution by deciding to wait for the 10- year test results from Grand Rapids before moving ahead. The council`s decision raised ire among members of the city`s various women`s clubs, who wanted dental protection for their children. The clubs mounted a peti-
tion drive that resulted in the city council`s reversing itself, deciding in November, 1949, to begin water fluoridation the following year.
When the council reversed itself, Wallace declared war. With a handful of supporters, he began his own petition drive and soon succeeded in forcing the city council to allow the voters of Stevens Point to decide the matter through a referendum.
Pro- and anti-fluoridationists were still forming their campaign strategies when the city council secretly decided to begin fluoridating the town`s drinking water in May, 1950. Council members apparently were convinced that the voice of scientific reason would win out and saw no reason to wait months for the referendum.
When the rank-and-file citizenry discovered the council`s secret plan, Wallace`s campaign began to gather sympathy and steam. Handbills appeared, demanding that the city ”Get the Poison out of our Drinking Water.” Wallace, in the eyes of many, may have acted foolishly, but he was no fool. In the early months of 1950 the U.S. Public Health Service still categorized fluoridation as ”experimental.” Wallace began tracking down testimony of medical school deans who agreed that fluoridation was still an experimental measure and who urged caution. Soon he had a list of his own ”experts”
taking an anti-fluoridation stance. They seemed every bit as impressive as the experts marshaled by his opponents.
Demonstrating a flair for show business, Wallace began handing out songbooks at his public meetings, rallying the townsfolk with old-fashioned sing-alongs. He used the tunes of popular melodies for lyrics he had devised himself. Thus, ”Good Night, Irene” became ”Good Bye, Fluorine!”
The spirited local donnybrook, with its carnival atmosphere and small-town populist flavor, hooked the attention of the national press. When the referendum finally was held on Sept. 19, 1950, word went out across the nation that fluoridation was rejected by the people of Stevens Point by a vote of 3,705 to 2,166.
Rejection of a public health measure in a Wisconsin city of 15,000 would not seem to mean much in the grand scheme of things. But the national attention the Stevens Point anti-fluoridation campaign garnered had a galvanizing effect. Almost overnight a loose national coalition of anti-fluoridationists sprang into action just as fluoridation was receiving official sanction as a scientifically proven safe and effective procedure to fight tooth disease.
Alexander Y. Wallace and the fight he led in Stevens Point showed the way for other anti-fluoridationists to oppose effectively through referenda the wishes of federal, state and local authorities. Community after community across America began to reject fluoridation proposals.
The people fighting fluoridation were a motley collection. Since the turn of the century, there had been a small but vocal opposition to other public health measures, particularly mass inoculations against disease, and now these same protesters became anti-fluoridationists.
Dental and medical authorities carefully described fluoridation as a simple adjustment of water content with an essential nutrient–fluoride–in sisting it was not a medicine. Technically, a medicine is a substance that treats or cures
a disease; fluoride can do neither. It is, rather, a naturally occurring substance that is contained in almost all foods. Some religious groups, particularly Christian Scientists, disagreed with that interpretation. They objected to fluoridation as enforced medication that went against their tenets of faith-healing and joined the opposition.
In 1950 the rabidly anti-Communist, right-wing politics of Sen. Joseph McCarthy of Wisconsin was on the ascendancy. McCarthyite politicians, the Ku Klux Klan (and later the John Birch Society) and other right-wing political groups all jumped on the anti-fluoridation bandwagon. Suddenly the political affinities and loyalties of dentists in the U.S. Public Health Service were called into question. Right-wing literature anonymously, shamelessly, ridiculously hinted that men like H. Trendley Dean might be Communist fellow travelers.
Other right-wing literature called fluoridation an elaborate Soviet plot. The Soviets were hoodwinking communities across the country, the theory ran, into thinking that adding fluorides to drinking water should be regarded as a public service, as essential as street cleaning and garbage pickup. Then, just as all Americans were lulled into complacency, Soviet agents would on a prearranged night pour hundreds of millions of tons of fluoride into community reservoirs across the country. That way, according to the theory, in a single day most of the U.S. population would poison itself, allowing Russian soldiers to take over every city, town and hamlet in America without firing a shot.
Alleged Communist conspiracies fascinated a great many Americans in the early 1950s. That fascination sometimes supplied well-credentialed but spurious and hysterically ill-informed ”expert” opinion to the anti-fluoridationist side.
Paul Manning, a Harvard-educated dentist, for instance, was convinced that fluoridation was ”chemical rape” instigated by ”Godless medical technocrats” using ”thought-control methods” devised by the advertising industry to sell fluoridation to an uncomprehending public. It was a ”neo-Marxist” plot, he said, the first step in giving the federal government control of ”who shall mate with whom and what the offspring shall be and when.”
Now, 36 years after the opening volley of the fluoridation wars, some of the hysteria has subsided. Fighting fluoridation, however, remains a popular right-wing cause and a surprisingly effective one. To this day, only 54 percent of the American public lives in communities with fluoridated water.
Many large metropolitan areas do not have fluoridation despite frequent attempts to get it in the last four decades, including 9 of the 50 largest cities in America: Los Angeles; San Diego; San Jose, Calif.; Phoenix; Tucson; Newark, N.J.; Portland, Ore.; Honolulu and San Antonio, which lost a referendum on the issue last year.
In fact, because of continuing opposition, only 17 percent of the citizens living in California, the most populous state in the nation, are served by fluoridated water supplies. Each year when communities around the country vote by referendum on whether to fluoridate, more often than not voters go against fluoridation.
The reason fluoridation usually loses seems to revolve around the same bugaboo raised by Alexander Y. Wallace in the Stevens Point
American Legion Hall meeting in 1949: poison. ”Why should we put a known poison in our drinking water?” fluoridation detractors continue to ask, using seemingly endless variations on the argument.
Fluorides can be toxic in great quantities, but so would nearly every other trace element and mineral found in ordinary drinking water. In minute quantities, fluoride has proven over and over to be perfectly safe. In older, larger communities that have always had naturally fluoridated water supplies, such as Jacksonville, Fla., 100-year studies of public health records have shown that fluoride has had no bearing whatsoever on public health–except that it prevents cavities.
Despite the record, anti-fluoridationists effectively fight for their cause by continually bringing up new alleged hazards from long-term use of fluorides in water. Through the years anti-fluoridationist s have accused fluoridation of causing cancer, heart disease, bone brittleness, anemia, diabetes, strokes, infertility, stillbirths, mongolism, premature aging and even nymphomania.
These charges are usually thinly documented, if at all, but it doesn`t really matter for the purposes of anti-fluoridationists. In an argument over the safety of fluoridation, the burden of proof necessarily lies with the pro- fluoridationists. By the time pro-fluoridationists have refuted claims that fluoridation causes heart disease, anti-fluoridationists are claiming it causes birth defects.
For example, in 1975, during a raging battle over fluoridation in Los Angeles, John Y. Yiamouyiannis, the nation`s leading anti-fluoridation crusader, released a study showing higher cancer death rates between 1950 and 1970 in 10 fluoridated cities compared to 10 unfluoridated ones. Yiamouyiannis is a biochemist with degrees from the University of Chicago and the University of Rhode Island. He has made a career of fighting fluoridation, traveling the world delivering lectures and hiring out as an expert witness, selling his pamphlets and books along the way. He also sells a line of kitchen distillers that he says remove fluorides and other contaminants from drinking water. They are priced from $449 to $1,149.
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Yiamouyiannis` cancer study was alarming enough that it was in turn studied by the National Cancer Institute, the Centers for Disease Control and the National Academy of Sciences. The follow-up studies all showed faulty statistical analysis by Yiamouyiannis. Most glaring, his study did not take into account differences between the cities in such factors as urbanization, industrialization and economic, racial and cultural characteristics of the populations that have been shown to increase the risks for certain types of cancer. For example, the fluoridated cities had a much larger aged population than the unfluoridated cities. When those variables were adjusted, both the fluoridated and unfluoridated cities had the same cancer rate.
Such explanations of statistical variables are sophisticated and sometimes difficult for the general public to follow, however. And when a carefully studied response comes weeks or months after the violent impact of the original accusation, it loses some of its force. In the case of the 1975 Los Angeles referendum, shortly after Yiamouyiannis` findings were released, voters overwhelmingly rejected fluoridation.
This is a singularly successful way to prey on the public`s fears. Tooth decay, as prevalent as it is, probably is not a burning issue in anyone`s mind, except possibly dentists`. Nor, for that matter, is fluoridation. In 1984 a national opinion survey revealed that only 2 percent of those Americans questioned mentioned fluoridation as an important preventive for cavities.
So when a small but effective group of anti-fluoridationists makes vague, faulty but impressive assertions of long-range health hazards due to extended exposure to fluorides, fluoridation often loses.
When ignorance and fear win out over the facts generated by a century of experience and an estimated 10,000 scientific studies proving fluoridation`s effectiveness and safety, the public pays. The Atlanta-based National Centers for Disease Control estimates that it costs 5 to 10 cents a year per person for fluoridation in Chicago, which has been fluoridated since 1956. Parents in an unfluoridated city who want their children to have the same protection as Chicago children must pay $5 to $10 for a single fluoride treatment in a dental office.
Interestingly, it still is not known exactly why fluoride prevents cavities, though many theories have been advanced. The leading ones are: 1) It reduces tooth enamel`s solubility in acids that cause cavities, 2) It rebuilds enamel in areas of early cavities, and 3) It changes the composition of plaque –the sticky, colorless cavity-producing film of bacteria that forms constantly on the surfaces of everyone`s teeth–or reduces the ability of plaque organisms to produce acid.